The author presents a case study of a hemophiliac boy in four-times-a-week analysis from the age of four to six and a half years. An extensive narrative of various phases of the analysis including the termination provides the reader access to the material for discussion of therapeutic action. Her analytic technique is based on a developmental point of view and illustrates the use of limits, play, and interpretation based on countertransference. She understands the boy's symptoms of preferring to be a girl, asking to cut his penis off, and wishing to die as defenses against the fear of castration, which in his case is aggravated by the actual threat of repeated medical interventions, and by the underlying fear of a lack of body composition. An unusual feature of the case is the illustration of the symptom, the analysis, and the recovery of the male self, captured in a complex collage that was made over the course of the relatively short analysis.Keywords: child analysis, hemophilia, cross-dressing, castration anxiety, body integrity anxiety, suicidality
PresentationMick Martin 1 presented as an engaging, bright, attractive, muscular 4½ year-old boy with dark curly hair and olive-toned skin. He has moderately severe hemophilia, treated after injury by injection of clotting factor at home and intravenous plasma in the hospital for more serious blows. He has been getting hurt and threatening to kill himself. He was afraid of the dark and of monsters especially at night. He sneaked and hoarded food. He preferred to play with girls, stole, hoarded and excitedly but guiltily wore his sister's clothes, and for the last year, he had wished to change into a girl. Like his older brother (also hemophiliac) Mick was physically active in games, fearless, and oblivious to the risk of injury. Once injured, however, he was terrified of needles, and unlike his brother he resisted intravenous treatment. His hematologist referred Mick for analysis on account of his persistent wishes to cut off his penis, become a girl, and die.
Psychosocial aspects of hemophiliaHemophilia, a disorder of blood clotting, passed to a male child through his mother's genes, causes bleeding, most often into the soft tissue and 1 To protect confidentiality for the analysand and his family, identifying details were changed. (2017) 98:71-90
Int J Psychoanal